Sustained Improvements in Peripheral Venous Catheter Care in Non-Intensive Care Units

A Quasi-Experimental Controlled Study of Education and Feedback

Mohamad G. Fakih, MD, MPH; Karen Jones, RN; Janice E. Rey, MT (ASCP); Dorine Berriel-Cass, RN, MA; Tatyana Kalinicheva, MD; Susanna Szpunar, MPH, DrPH; Louis D. Saravolatz, MD

Disclosures

Infect Control Hosp Epidemiol. 2012;33(5):449-455. 

In This Article

Abstract and Introduction

Abstract

Background and Objectives. Peripheral venous catheters (PVCs) can be associated with serious infectious complications. We evaluated the effect of education and feedback on process measures to improve PVC care and infectious complications.
Design. Quasi-experimental controlled crossover study with sampling before and after education.
Setting. An 804-bed tertiary care teaching hospital.
Participants. Nurses and patients in 10 non-intensive care units.
Methods. We implemented a process to improve PVC care in 10 non-intensive care units. The 4 periods (each 3 months in duration) included a preintervention period and a staggered educational intervention among nurses. During intervention period 1, 5 units participated in the intervention (group A), and 5 units served as a control group (group B). Group B underwent the intervention during intervention period 2, and both groups A and B received feedback on performance during intervention period 3. Process measures were evaluated twice monthly, and feedback was given to nurses directly and to the unit manager on a monthly basis.
Results. During the preintervention period, there were no significant differences between groups A and B. Of 4,904 intravascular catheters evaluated, 4,434 (90.4%) were peripheral. By the end of the study, there were significant improvements in processes, compared with the preintervention period, including accurate documentation of dressing (from 442 cases [38%] to 718 cases [59%]; P < .0001), catheter dressing being intact (from 968 cases [88.5%] to 1,024 cases [95.2%]; P < .0001), and correct demonstration of scrubbing the hub before infusion (from 161 demonstrations [54%] to 316 demonstrations [95%]; P < .0001). There was a significant reduction in PVC-associated bloodstream infection, from 2.2 cases per 10,000 patient-days during the preintervention period (5 cases) to 0.44 cases per 10,000 patient days during the 3 intervention periods (3 cases; P = .016).
Conclusions. Education and real-time feedback to nurses increases and sustains compliance with processes to reduce the risk of infection from PVCs.

Introduction

Catheter-associated blood stream infection (CABSI) leads to significant morbidity and cost[1], and the majority of these infections are preventable. Efforts to reduce infection include training healthcare workers (HCWs), ensuring compliance with the appropriate measures when placing or managing a line, prompting removal of catheters that are associated with a high risk of infection or are no longer needed, and providing feedback to improve HCW accountability.[1,2] Many efforts to reduce these infections have focused on central venous catheters and intensive care units[3,4,5]; efforts have been less commonly documented in the non-intensive care setting.[2] Peripheral venous catheters (PVCs) are the most commonly used catheters in hospitals.[6,7] Previous studies have reported poor compliance with the care of the PVC[8,9,10,11] and serious events related to infectious complications.[12,13] At our facility, we have noted less than optimal documentation related to PVCs in the patient records in addition to room for improvement in maintenance and care. We have also evaluated cases of septic thrombophlebitis resulting in adverse outcomes. In an effort to reduce the infection risk, we implemented an intervention focused on improving the process measures related to the care of the PVC through nurse education and feedback on performance in the non-intensive care setting.

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